troke” or “transient ischemic attack”

(TIA) occurs when there is a temporary

drop in the blood supply to the brain.

Various events or conditions can cause the brain to be deprived

of oxygen. Symptoms of a transient ischemic attack (TIA) are
similar to those of a stroke, but they do not last as long.

It is estimated that up to 500,000 people in the United States

experience a TIA each year.

Because symptoms fade away rapidly, most patients do not seek

medical help. However, between 10-15 percent of TIA patients
have a full-blown stroke within 3 months. This is why
recognizing the signs of a TIA and seeking medical attention is
important.

Rapid evaluation and treatment of people who experienced a

mini-stroke, either in specially designed TIA clinics or the
emergency room, can significantly reduce the risk of a
subsequent stroke.
Fast facts on TIA
 A mini-stroke occurs when blood is temporarily cut off to
regions of the brain.
 Around 500,000 Americans have a stroke each year.
 Rapid care is essential to minimize the medical
implications of a stroke.
 The object of TIA treatment is to prevent further
occurrences.
 One of the most common drugs used to prevent TIAs is
warfarin, an anticoagulant medication.

What is a TIA?
 The acronym FAST represents the signs and symptoms of stroke.
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A transient ischemic attack (TIA) is like a stroke in that it

produces similar symptoms, but it only lasts a few minutes and
causes no permanent damage. It is sometimes called a mini-
stroke.

It happens when there is not enough oxygen reaching the brain.

This is often due to a blood clot that remains for a short while.

When the clot breaks up or moves on, symptoms subside.

The American Stroke Association (ASA) urges people not to
ignore a TIA, as it can be a warning of a future, full-blown
stroke.

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Symptoms
People with TIA experience varying symptoms, depending on
which part of the brain is affected.

The signs and symptoms of a TIA are represented by the

acronym FAST (Face, Arms, Speech, Time):

 Face: The face may fall on one side as some of the facial
muscles become paralyzed. The person’s eye or mouth may
droop, and they may be unable to smile properly.
  Arms: Arm weakness or numbness might make it hard for
the individual to either raise both arms or to keep them
raised.
 Speech: Speech may be slurred and garbled.
 Time: If just one of these symptoms are present, it is time
to dial emergency services.

Being able to identify the signs and symptoms present in FAST

is especially important if you live with somebody in a high-risk
group, such as an older adult, or an individual with high blood
pressure or diabetes. FAST is also a reminder that the sooner
medical treatment is sought, the better the chance of recovery.

Other signs and symptoms of a TIA can include:

 dizziness
 difficulty talking
 difficulty understanding what others are talking about
 problems swallowing
 very bad headache
 paralysis, numbness, or weakness on one side of the body
 in severe cases loss of consciousness
If anybody experiences any of these signs and symptoms
themselves or witnesses anybody else experiencing them,
medical attention should be sought immediately. TIA symptoms
are temporary and should disappear within 24 hours. They may
last from 2-15 minutes.

Which conditions can mimic a TIA?

Recognizing a TIA can be complicated, especially as other

conditions can produce similar symptoms and bodily effects.

These include:

 low blood sugar

 migraines
 minor seizures

The way to rule out these other conditions is that a TIA will
often heavily impact one part of the body, such as sensation and
movement in a single limb or vision. This is due to a TIA’s
effect in blocking a single blood vessel. Conditions that mimic a
TIA will generally cause bodywide neurological symptoms,
such as tingling or fainting.
To prevent TIA developing into a full-blown stroke, it is vital to
have any symptoms checked that could suggest the presence of a
TIA.

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Causes
A TIA happens when the supply of oxygen to the brain is
disrupted.

Disruption of blood supply

Two main blood vessels called the carotid arteries supply blood
to the brain. These arteries branch off into many smaller blood
vessels. A TIA can occur if one of the smaller blood vessels
becomes blocked, depriving that part of the brain of oxygen-rich
blood.

Atherosclerosis

Atherosclerosis causes arteries to narrow. Fatty deposits develop

on the inner lining of blood vessels, causing them to become
hardened, thickened, and less flexible. This makes it much more
difficult for the blood to flow around the body.

Blood clots

A blood clot can disrupt the supply of oxygen-rich blood to parts

of the brain. Blood clots are usually caused by:

 Heart conditions, such as congestive heart muscle disease

or atrial fibrillation.
 Blood conditions, including leukemia (blood cell cancer)
and sickle cell anemia.
 Infections.

An embolism is a blood clot from one part of the body that

becomes dislodged and travels into one of the arteries that
supplies the brain. An embolism can cause a TIA.

Hemorrhage (internal bleeding)

A minor brain hemorrhage (small amount of bleeding in the

brain) can cause a TIA; however, this is rare.
Risk factors
Risk factors for TIA include ethnic origin, age, and family history.
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There are some risk factors for TIA that can be changed, and
others that cannot.

Risk factors that cannot be changed:

 Family history: People with a close relative who has had a

stroke or TIA.
 Age: People aged over 55 have a higher risk of having a
TIA.
 Sex: Males are at slightly greater risk.
 Ethnic origin: People of black African ancestry have a
higher risk.

Risk factors that can be changed:

 Hypertension, or high blood pressure.

 Cardiovascular disease: People with cardiovascular
diseases are at greater risk of having a TIA. This includes a
heart defect, heart failure, or arrhythmia (abnormal heart
rhythm).
 Carotid artery disease: This develops when blood vessels
in the neck leading to the brain are clogged.
 PAD (peripheral artery disease): When blood vessels that
carry blood to the arms and legs become clogged.
 Smoking: People who smoke increase their risk of
developing various diseases and conditions, including TIA
and stroke.
 Sedentary lifestyle: People who are physically inactive
have a significantly higher risk.
 Diabetes: People with diabetes are more likely to suffer
from atherosclerosis (narrowing of the arteries due to a
buildup of fatty deposits).
 Bad diet: Individuals who consume too much bad quality
fat and or salt have a higher risk of stroke and TIA.
 Blood cholesterol levels: If blood cholesterol levels are
high, it increases the risk of TIA or stroke.
 Homocysteine levels: Homocysteine is an amino acid
produced by the body as a byproduct of consuming meat.
Elevated levels of homocysteine in the blood can make the
arteries thicken and scar; they are more susceptible to
clogs.
  Bodyweight: Obese people have a significantly higher risk
of having a TIA or stroke.
 Alcohol: People who drink large quantities of alcohol
regularly are also at higher risk.
 Illegal drugs: Some illegal drugs, such as cocaine, can
raise the risk of stroke or TIA if taken often enough.

Treatment
Treatment will depend on the cause of the TIA. The doctor may
prescribe medication that lowers the risk of a blood clot, or
recommend surgery or an angioplasty.

TIA medications

The type of medication prescribed will depend on what caused

the TIA, how severe it was, and what part of the brain was
affected.

Anti-platelet drugs: These make platelets in the blood less likely

to stick together and form a clot that can block blood flow. Anti-
platelet drugs include:
Aspirin and dipyridamole: Some doctors may prescribe
Aggrenox, which contains both aspirin and dipyridamole. Some
doctors may recommend ticlopidine (Ticlid).

Side effects of aspirin can include:

 indigestion
 nausea
 ringing in the ears
 stomach irritation and bleeding

Side effects of dipyridamole may include:

 diarrhea
 dizziness
 headaches
 nausea

Clopidogrel: If a person has experienced severe side effects

from taking aspirin, had a further TIA despite taking aspirin, or
has arterial disease, the doctor may prescribe clopidogrel
(Plavix).
Side effects of clopidogrel may include:

 abdominal pain
 bleeding
 bruising
 diarrhea
 indigestion

Anticoagulants: Anti-coagulants interfere with many other

medications, other over-the-counter drugs, and herbs. Always
talk to your doctor before taking any other medication or herbs
when on anticoagulants.

Anticoagulants include:

Warfarin (Coumadin) and heparin: Warfarin can be used

long-term, while heparin is used short-term.

Side effects of warfarin: The most serious undesirable side effect of warfarin is bleeding. Any
patient on warfarin who has any of the following symptoms should tell their doctor immediately:

Other side effects may include:

 blood in urine
  blood in feces (either specks of blood, or feces are black)
 severe bruising
 nosebleeds that persist for more than 10 minutes
 blood in vomit
 coughing up blood
 unexplained headaches
 bleeding from the vagina
 heavy or increased bleeding during menstruation

Medications for hypertension: Various medications are

available to treat blood pressure. However, if an individual is
unfit and overweight, blood pressure can often be brought down
by losing weight, doing exercise, getting at least 7 hours good
quality sleep every night, and eating a well-balanced healthful
diet.

Medications for cholesterol: As with hypertension, losing

weight, following a well-balanced diet, doing regular exercise,
and sleeping at least 7 hours every night can help bring
cholesterol levels back to normal. Sometimes medications are
necessary and the person may be prescribed a statin, which helps
reduce the production of cholesterol.
Surgery

An operation called a carotid endarterectomy involves removing

part of the lining of the damaged carotid artery, as well as any
blockage that has accumulated in the artery.

This operation is not suitable for people whose arteries are

nearly completely blocked. Even some people with partial
blockage may not be suitable for this procedure because of the
risk of stroke during the operation.

Diagnosis
A number of tests may be necessary to fully understand the neurological causes of the TIA.
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Anybody who has signs and symptoms of a TIA should seek

medical attention immediately. As TIAs do not last very long, it
is possible that the symptoms will have disappeared by the time
the person gets to see their doctor.

If at all possible, the person should take someone who witnessed

the event with them; so that they can share what symptoms they
saw.
The doctor may need to carry out a neurological examination,
even if symptoms have gone. This will include some simple
tests to check skills, such as memory and coordination.

While being examined, the doctor will ask the person questions
regarding symptoms, such as:

 How long they lasted?

 What they were like?
 How the symptoms affected them?

The answers given will help the doctor rule out any other
conditions that may have similar symptoms.

If the doctor believes the person had a TIA, they will be referred
to a neurologist for further testing. The specialist may order a
number of tests designed to identify the underlying factors that
caused the TIA.

The tests include:

 Blood tests: Tests will check blood pressure, cholesterol

levels and clotting ability.
  Electrocardiogram (ECG): This records the electrical
activity and rhythms of the heart.
 Echocardiogram: This is an ultrasound scan that checks
the pumping action of the person’s heart.
 Chest X-ray: This helps the doctor rule out other
conditions.
 CT scan: The scan creates a 3-D image that can
show aneurysms, bleeding, or abnormal vessels within the
brain.
 MRI scan: An MRI gives a more detailed view of the brain
than a CT scan, and helps identify any brain damage.
 Ultrasound: A wand waved over the carotid arteries in the
neck can provide a picture that indicates any narrowing or
clotting.

Prevention
Smoking is a significant risk factor in strokes.
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The measures below can help reduce the risk of having a TIA,
stroke, or a recurrent TIA:
 Giving up smoking reduces the risk of stroke, TIA, and
many other conditions.
 Following a well-balanced diet, with plenty of fruit and
vegetables, whole grains, fish, poultry, and very lean meat.
Avoiding all junk foods and foods with bad fats, such as
saturated and trans fats, may also be helpful.
 Reducing salt (sodium) intake. Individuals prone to high
blood pressure should avoid salty foods and not add salt to
cooking.
 Exercising moderately for at least 30 minutes five times a
week. However, people should check with their doctor
before they begin an exercise program.
 Reducing the amount of alcohol consumed. Either don’t
drink alcohol at all, or stay within the daily recommended
limits.
 Losing weight and bringing body weight down to normal
levels will decrease risk.
 Taking illegal drugs, such as cocaine, significantly raises
the risk of stroke and TIA.
 Controlling diabetes through proper medication and
sticking to treatment plans greatly reduces the risk of stroke
and TIA.
  Getting at least 7 hours good quality, continuous sleep
every day.
 Stroke
 Cardiovascular / Cardiology
 Neurology / Neuroscience

6 sourcescollapsed


Medically reviewed by Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT on
December 13, 2017 — Written by Yvette Brazier